Provider Demographics
NPI:1649750753
Name:LIVENGOOD, TARA (PSYD)
Entity type:Individual
Prefix:DR
First Name:TARA
Middle Name:
Last Name:LIVENGOOD
Suffix:
Gender:F
Credentials:PSYD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:1315 W 17TH ST UNIT 15034
Mailing Address - Street 2:
Mailing Address - City:PANAMA CITY
Mailing Address - State:FL
Mailing Address - Zip Code:32406-7702
Mailing Address - Country:US
Mailing Address - Phone:850-276-6401
Mailing Address - Fax:850-792-6916
Practice Address - Street 1:1315 W 17TH ST UNIT 15034
Practice Address - Street 2:
Practice Address - City:PANAMA CITY
Practice Address - State:FL
Practice Address - Zip Code:32406-7702
Practice Address - Country:US
Practice Address - Phone:850-276-6401
Practice Address - Fax:850-792-6916
Is Sole Proprietor?:No
Enumeration Date:2018-08-17
Last Update Date:2025-02-12
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
TX39532103TC0700X
FLPY10222103TC0700X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes103TC0700XBehavioral Health & Social Service ProvidersPsychologistClinical